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WHO/ERS Digital Health Agenda for the End TB Strategy

Dennis FALZON, MD Global TB Programme, WHO/HQ, Switzerland

21st Annual Conference of the Union North America Region Vancouver, BC, Canada

February 25, 2017

Speaker conflict disclosure: none The presenter is a staff member of the World Health Organization (WHO). The Global TB Programme of WHO is supported by USAID, the European Respiratory Society, the Global Fund to Fight AIDS, TB and Malaria, and BMGF for activities in support of digital health for TB control. The funders were not involved in the preparation of this presentation.

Objectives of the presentation

• Outline the agenda document and events leading to its creation

• Present the vision of WHO and partners on future action along the path mapped by the agenda

WHO/ERS consultation, February 2015

Experts from different areas: digital health developers, TB, clinical, public health, national TB programmes, technical agencies, donors

-> Global task force for digital health and TB

-> Conceptual framework for digital health & TB

-> “Agenda for action”

-> Target product profiles

WHO global task force on digital health and TB

To advise WHO/GTB on:

• the development of digital health products that are aligned to the challenges posed by TB to health care providers and patients

• the approach to the review of evidence and best practices for the effectiveness of digital health interventions in TB care and control

• how to support WHO Member States to scale up digital health technologies for TB care and control based on existing knowledge

Patient care

Surveillance eLearning

Programme management

Conceptual framework for digital health & TB

“… if your initiative isn't increasing effectiveness or efficiency (or both) then you shouldn't be doing it.”

John BONTEMPO linearityofexpectation.blogspot.ch

What evidence?

PILOT PROJECT

STUDIES

CONCEPT

EVIDENCE REVIEW

POLICY CHANGE

How scalable? the ability to handle a growing amount of work in a capable manner or its ability to be enlarged to accommodate that growth

Estimated incidence, 2015

Estimated number of deaths, 2015

1.4 million* (1.2–1.6 million)

10.4 million (8.7–12.2 million)

580,000 (520,000–640,000)

All forms of TB

Multidrug- / rifampicin-resistant TB (MDR/RR-TB)

HIV-associated TB 1.2 million

(1.0–1.3 million)

390,000

(320,000–460,000)

Source: WHO Global Tuberculosis Report 2016 * Excluding deaths attributed to HIV/TB

250,000 (160,000–340,000)

The global TB situation

Integrated, patient-centered TB care

and prevention

Bold policies and supportive

systems

Intensified research

and innovation

End TB Strategy Pillars & Principles

The «Agenda for Action» & the End TB Strategy

“Agenda for action”

The strategic direction that WHO is mapping out to integrate digital health into preventive and care activities for the different components of the End TB strategy Comments on the evidence and an outline of the target product profiles

Sep 2015

Target product profiles (TPP) (1) for priority digital technologies for TB

Function TPP : short description

Patient care 1. Video treatment support (VOT) via mobiles

2. eHealth portal

Surveillance &

monitoring

3. Graphic dashboards

4. eNotify

5. eReporting of adverse events of treatment

Programme

management

6. Diagnostic device connectivity

eLearning

7. Patient information platform

8. Web-based training for health care professionals

9. Clinical decision support systems

ERJ; 2016

Target product profiles (TPP) (2) for priority digital technologies for TB

WHO/ERS events at scientific meetings 2015-2017

• ERS Summit (Brussels, Jun 2015) • ERS Congress (Amsterdam, Sept 2015) • UNION World Conference (Cape Town, Dec 2015) • UNION Eur. Region Conference (Bratislava, Jun 2016) • ERS Congress (London, Sept 2016) • UNION World Conference (Liverpool, Oct 2016) • UNION N. American Region Conference (Vancouver,

Feb 2017)

Implementation guide on the digital technologies being used of connect GeneXpert machines and other diagnostic platforms

Oct 2016

Electronic case-based surveillance e.g. DHIS2 for dis-/aggregated recording

Benin (October 2015; May & October 2016) ^ Kampala (December 2016)

eLearning apps e.g. PAL in Belarus

mHealth for TB-Tobacco: A technical workshop Cairo, February 2016

Outcome: a library of text messages on TB and tobacco which can address patients and health care workers

2nd WHO/ERS technical consultation, 7-8 February 2017

1. Evidence 2. Country experience 3. Funders’ perspectives 4. Concepts for tomorrow

Precision medicine and other future perspectives • Other approaches to adherence support not

currently covered by existing TPPs (e.g. medication monitors, ingestible devices)

• Nanotechnology for TB treatment delivery and TDM

• Artificial intelligence to extend the reach of today’s products

• Drones as a means to improve programme logistics and articulate with various digital technologies

Conclusion • Vast potential of digital health in action against major

diseases like TB

• WHO started process of evidence-based policy on use of digital technologies

• Evidence base for role in TB efforts is emerging but challenged by resources, rapid evolution of technologies, study design, concepts like precision medicine … in some areas the evidence will probably be limited to contextual narratives

• Nonetheless clinicians, managers, patients are bound to employ digital technologies and therefore the demand for evidence is likely to grow

Acknowledgements (1) • N American UNION Conference

organisers for inviting WHO

• Global task force on digital health for TB

• National TB programmes

• European Respiratory Society

• Many other technical and funding partners

• WHO colleagues

Acknowledgements (2) Collaborative group on the impact of digital technologies on TB (alphabetical order)

I Abubakar, N Alipanah, M Bastos, D Boccia, T Cohen, D Chin, J L Davis, C Denkinger, D Falzon, K Fielding, G J Fox, C Free, R S Garfein, A Hayward, E Jaramillo, B Kermu Ngwatu, R Lester, J Lewis, B Mappin-Kasirer, F Marx, D Menzies, GB Migliori, P Nahid, L N Nguyen, P N Nsengiyumva, O Oxlade, K Siddiqi, K Schwartzman, A Story, A Trajman, B V Thomas, M Yassin